Be a Doctor in Nine Months!

I recently passed a client who was chatting up a student intern. Although I hadn’t actually heard it, I thought I’d heard him say that he was taking a nine month course to be a doctor. It was funny but I sighed when I thought about all the people I come across who act as though they are medically trained physicians.

There’s an old joke about the patient who was scheduled to have surgery in the morning. After receiving her preoperative instructions, she asked the surgeon if she could possibly eat after midnight. Not having breakfast on the day of the surgery seemed undoable. The surgeon said no- she had to fast. The woman then asked the nurse who confirmed that no way should she eat! There might be all sorts of complications and the surgery would have to be canceled. The woman finally asked the maintenance worker who was checking out the lighting fixture over the bed. He shrugged and said, go ahead. Well, you get my point.

Many of us practice medicine in obscure ways. Stopping an antibiotic before the entire prescription is finished because we feel better is one of those ways. We scourge our medicine cabinets for what’s left of the medicine when our symptoms come back or our spouses have similar complaints of scratchy throats or runny noses. Those germs probably ate those antibiotics like Tic-Tacs. Yummy!

We may have decided to stop our antidepressants because a week after beginning them our sadness, tears, and inability to sleep persisted. We swore it didn’t work! Most antidepressants won’t work like an aspirin. Have a headache? Take an aspirin and ‘POWEE ZOWEE!’ we’re better. It may take up to several weeks after consistent med taking before we notice we got up easily and went out for a walk to enjoy the birds chirping.

I’ve probably met with four people within the last year that admitted they didn’t fill the prescriptions I gave them. Their well-meaning relatives dissuaded them because they were afraid the client would end up walking like a zombie. They’ve even attributed the symptoms of the illness to side effects of the medication. Hallucinations are usually not a side effect of a medication but find out if you have questions and concerns. If something new shows up after starting a medication call your doctor or nurse practitioner. Get the information from them, not the Internet or your sister-in-law’s mother’s cousin.

Sometimes, I must admit, as a driver I have a hard time letting the cab driver getting me to a destination. I would like to tell the short order cook exactly how to make those scrambled eggs at a diner but I restrain myself. I like to do it myself!

Sadly, I once knew a woman who complained of severe stomach pain that radiated to her back. It woke her up in the middle of the night a few times. I suggested she go to the emergency room or at the very least give her doc a call. Instead she chose to look up a natural herbal tea remedy for gas. The lady passed away soon after from a massive heart attack. I despise messages that promise doom and gloom. I just hope that we realize that we are first responsible for ourselves and sometimes that means talking to a medical person and not trying to be our own doctors. Most medical practitioner schools are years long and can’t be completed in nine months.

 

 

Depression Doesn’t Rock- Part three of three

If you go to a barbershop long enough you will probably get a haircut. So, if your mental health practitioner suggests medication after the assessment, don’t be surprised. “I don’t want medication,” is something I hear all the time. Sometimes I shudder and sometimes I breathe a sigh of relief. There are different ways to combat depression; there is no one right way. It’s up to you and your practitioner to figure what the best course of action is for you.

Medication- There are many medications out on the market that could help your mood. This is a definite area for you and your prescriber to talk about. Please don’t take the pills that the doctor prescribed for your cousin Ruth. Medications are metabolized in different organs, have different side effects and shouldn’t be used in various health conditions. You will probably need blood lab work done before and during your time on an antidepressant. Ruth means well but, really, she doesn’t have a medical degree. Same goes for when you decide you want to stop taking them. This is just as important as when you start. Don’t catapult your body into a crisis, it just got out of one, don’t go into another if you can help it. And you can.

 Exercise- After a physical check up and receiving the “ok” on starting an exercise routine you can actually begin one. Maybe you were running daily, had an injury and had to stop temporarily, but never quite laced up your running shoes again. Your body is probably screaming at you. “Hey where are those endorphins? I love them. I need them!” If for some reason you can’t go back to a previous sport think about alternative routines. Swimming, biking, weight training, speed walking, the list goes on… Walking around the corner to stop at the bank, then the grocery store, with a stop at the pharmacy, is not exercise. It adds to your overall conditioning but there’s nothing like giving yourself your “special time for me.”

Good nutrition- Seriously, that cheeseburger may taste delightful but your body probably needs something different. Fruits, veggies, whole grain foods, yogurts, lots of water…yummy! The last time you made a fruit smoothie, didn’t you feel great? I also think there’s something to preparing fresh food for yourself. It’s a gift. Taking care of yourself I mean.

Alcohol and marijuana- I know, everyone who has a beer or another substance “to relax” will argue the point. That’s okay. Just know that alcohol and marijuana are depressants, voila, “relaxation.” Each time you put some into your body you are laying on the depression. Depending on how many times a day you find you’re “opening up a cool one,” you’ll probably feel cranky and irritable when you stop this form of relaxation, but eventually you will be less depressed. If you’re using these a lot consider asking your doc the best way for you to taper off, you might need professional help.

Therapy- Talk isn’t cheap. Psychotherapy costs but it’s well worth it. I always say there’s nothing better than talking about yourself for forty five minutes at a clip. There are therapists who will offer a sliding scale fee if you think you can’t afford it. There are different types of therapy, cognitive behavioral, psychoanalytic, psychodynamic, different strokes for different folks. Try it. I feel better just thinking about my days on the couch.

Complementary Healing Techniques- Reiki, Therapeutic Touch, herbs, the use of crystals, Tibetan Bowls. These are just some of the forms of healing that can be used with and without medication and therapy. There are complementary healing practitioners that are available to discuss what forms might work best for you. They work even if you might be skeptical to begin with. We don’t stop at our skins. These measures have been used for centuries because they are effective. If you aren’t well versed in these techniques speak to someone who is, I don’t suggest trying them if you have no idea what you are doing.

Meditation- Go inside, people. We learn a lot about ourselves. What we need. Who we are. What makes us feel the fullness and joy of life. By going within we allow ourselves to listen to the inner voices that nudge us into being who we are meant to be and depressed isn’t it.  

Figure out the cause- not by yourself though. As I wrote in an earlier segment, depression has different causes. Yours might be long term, chronic, low level or profound. Read up on depression and go to a health professional. Get yourself acquainted with the various ways to feel better. Often times when we’re depressed we isolate and feel alone. That is a symptom of depression. Reach out for help and you’ll be whistling ‘Happy Days are here again!”

Any thoughts? Leave a comment! Would love to hear from you.

Depression Doesn’t Rock- Part Two of Three

A change of scenery or a nice hot bubble bath has done nothing to pull you out of your blue mood. While listening to your favorite love songs you actually felt worse, not better. I hope that by now you’ve gone to see your primary doc and are set to see a mental health practitioner. What should you expect? First off, someone who gives you eye contact, so you should do the same. Meet them at eye level, it works. You two should be partners in getting you better and back to being yourself!

 Be on the same page-

First off, the practitioner will ask you why you’re there. Different people go for different reasons. The evaluating person needs to know what’s bothering you. We all have different priorities and limits. I’ve sometimes thought a person should be on medication and they’ve been appalled by the idea. The symptoms of depression may be quite intense but you would have to agree. Don’t you think? Sometimes people are radically against medication but don’t tell me that until way late during the session. You may choose to bring it up early. I’m conservative. So while medication most frequently helps a person to climb out of depression it’s not the only strategy. Sometimes, I’ve been the one who’s appalled. There is help on the horizon and if somehow you’ve managed to make it to a prescribing clinician, there’s something important about that. Get the information you need. You can always rethink your decision after you’ve sifted through it. Or not.

Answer what’s asked-

Sounds simple but sometimes it’s not. A person can feel vulnerable answering personal questions about themselves. Sometimes it’s not in one’s culture or tradition to tell what’s really going on. You won’t get a bad grade, if you’re honest, honest. No one is going to contact your job or husband if you spill the beans on what’s really going on in your head. Sometimes people are afraid that it’s going to be on “a record.” Practitioners do keep documents but these are private. There has to be one-otherwise how can they possibly remember all the details that make you who you are? You want them to remember that you began sleepwalking with a particular pill you took that was supposed to help you get a good night. You wouldn’t want them to prescribe it again if they could help it.

Expect confidentiality-

Your mental health practitioner is not going to tell anyone anything. Unless, of course, you’re hell bent on hurting yourself or someone else. Your practitioner wants you safe and protected. You may not be able to do that if you are very depressed. That’s what we’re here for, remember? That’s why you came for help. If your mental health doctor thinks someone else should know, they will talk that out with you. Yes, it may lead to the hospital but that’s only if you really need it. Really.

Try not to laugh-

Some people think it’s funny when the practitioner asks whether a person hears voices or sees things they don’t believe others are sharing. It’s what we ask. Guess what? A percentage of people who are depressed actually do experience auditory and visual hallucinations. This type of depression is called Major Depression with Psychotic Features. Yes, you can get better-even if you are a little paranoid. There is medication that will help you and you can get back to enjoying the good things in life. Yippee!

Don’t be shocked-

You will probably be asked how much wine you drink or marijuana you smoke to help you sleep or relax. These are known to be depressants. The practitioner might ask you if you are sexually active or having trouble with intimacy. Sometimes a person’s libido goes south of the border when they’re depressed.

Expect questions about your medical health-

The practitioner will ask about your physical condition, may send you for blood work and may ask for permission to chat with your primary care physician. Sometimes our physical and medical selves get cross-fused. We might think it’s one thing but it’s another. A test or a conversation can help clarify for a safer treatment plan for you.

Bring a list of questions-

I’m not talking about testing your clinician on his or her knowledge of the brain and nervous system, unless for some reason you really need to know. They have licenses and board certification attesting to that knowledge and time is short. Ask about your diagnosis, possible treatments, medications if needed and potential side effects. Ask about how long you may need to be on medication before it’s discontinued. Question whether the medication that’s prescribed can be taken if you are planning on attending an extravagant wine testing from Thursday to Sunday. You get my drift. Ask what pertains to you.

Next week I plan to talk about different strategies available for mood disorders.

Are there any other questions you’ve asked or would like addressed? Let me know. Just hit the comment section.

Remember you are never alone!

Depression Doesn’t Rock- Part one of three

Many of us get depressed at some point in our lives. Just like people come in all types of shapes, sizes and colors, depression can be viewed in the same way. What I may describe as feeling depressed may be a bit different from your own brand, but there are similarities across the board.

Four people come to mind when I think of the faces of depression. Their descriptions don’t encompass all types, so if you have something to add, please do, there’s a comment section at the end of this blog entry.

First off, there’s Sleepy Stan. His kids have been trying to get him to test out their scooters at the park on Saturday afternoon. He waves them away because he’s tired. He would prefer to hang out on the sofa with a pillow over his head. Stan promised to get up. Later. His wife hopes when he does that he’ll take a shower this time. Up to now, he’s still managing to get to work but his family misses Saturdays at the park. They haven’t taken an evening walk for ice cream cones all season. The reality is that Stan misses his family too. He can’t seem to get a move on as much as he’d like to and it makes him feel even worse.

Then there’s Famished Frances. She’s been eating a lot more than usual. Her appetite has taken off and she gazes in dismay at the scale she’s finally had the nerve to stand on. Franny’s also a worrier. She’s up at night thinking about her problems, large and small. At first she feels better making those Dagwood sandwiches. They kind of fill that empty space in the middle of her belly and she stops worrying. But then, a few minutes later, she’s worrying again. This time her concerns include how much weight she’s gained and her fear that she’ll never be able to stop eating. Franny seems to remember her mom and her aunt doing the same thing when she was little and wonders if it runs in the family.

How many of you know Irritable Ivan? He’s pissed and he’s just not the same guy you used to know. Everything you say to Ivan seems to rub him the wrong way. He’s annoyed at his brother-in-law who got him tickets for the game, but didn’t tell him he had to pay for his hot dogs. He’s starting to get agitated a lot and has begun to pace. Ivan thinks he’s mad at his wife but then again, it might be all those people on the train who’ve annoyed him today. He really doesn’t like feeling this way. In fact, his boss told him he should consider taking a few days off so he could cool down.

 Melancholy Mona sits in her dark living room. Her partner, Lisa, told her that the least she could do was put the lights on. When she said that, Mona started crying again. Everything seems to push her into a puddle of tears. She wasn’t always like that. It seems like such a long time since she felt good about herself. So long, that she’s been thinking scary thoughts. Mona is almost certain that no one cares about how sad she feels. She’s started to think that maybe it would be better if she weren’t even around. Lisa made an appointment for Mona to talk to their family doctor. She said that she needs help- professional help.

Do you relate? Sometimes we find ourselves experiencing life the way Stan, Ivan, Franny and Mona have been. It could be just a matter of needing a break from the world; it could be a lot of things. It might actually be a thyroid problem or some other medical illness. Depression can be serious and you might want to take a look at it. The following are bonafide signs and symptoms of depression that are found in the DSM-IV TR, the bible of psychiatry.

See if some of what you’re feeling fits in the following list.

–          Feeling depressed most of the day, everyday.

–          Less interested in activities, a loss of feeling of pleasure

–          Significant weight loss or weight gain- maybe 5% in a month

–          Difficulty sleeping at night or sleeping just too doggone much

–          Feeling agitated or slowed down

–          Fatigue or loss of energy

–          Feeling worthless, excessive or inappropriately guilty

–          Have problems concentrating, thinking and indecisiveness

–          Thinking about death, not just dying but suicidal thoughts- with or without plans to do yourself in and having intention to take action.

Sometimes, the depressed person is the last to see their symptoms. They might be blaming themselves for whatever it is they’re feeling and not realize that it’s symptoms of depression. It is probably not something they can just shake off.

If you believe that you may be experiencing some of the items on the list you should consider talking to a professional. It wouldn’t hurt. Your doc can evaluate you or send you to a mental health professional. Don’t depend on your best friend or great aunt Maggie who suffered from depression a decade ago. You deserve talking to a professional.

Next week, I plan to blog about what to expect when you do see a mental health professional. The following week, I’ll blog about different treatments for depression. Stay tuned. In the meantime, lift up those roman shades and let the sun pour into your living room, maybe take a nice walk…

Tell me what you would like to know about depression. I’d also love to hear helpful strategies that you might be aware of!

Here are some other sites that will give you information on depression:

http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml

http://www.webmd.com/depression/default.htm